A 29-year-old woman with pre-gestational diabetes mellitus is admitted in active labor at 38 weeks. She is on an insulin infusion protocol. Her blood glucose is 148 mg/dL. What is the most appropriate insulin infusion rate adjustment according to standard intrapartum glucose management?

• A Increase insulin infusion rate; target intrapartum glucose is below 140 mg/dL ✓
• B Maintain current rate; target intrapartum glucose is 70-110 mg/dL
• C Increase insulin infusion rate; target intrapartum glucose is 120-140 mg/dL
• D Decrease insulin infusion rate to prevent maternal hypoglycemia; target intrapartum glucose is 100-140 mg/dL

Explanation

During labor, the target maternal glucose is below 140 mg/dL (some protocols use 70-110 mg/dL or below 120 mg/dL) to prevent neonatal hypoglycemia. At 148 mg/dL, the insulin infusion should be increased. Distractor B is wrong because 148 exceeds the target range. Distractor C is wrong because 148 already exceeds the 120-140 range upper limit. Distractor D is wrong because decreasing insulin at 148 mg/dL would not address hyperglycemia, and the primary concern is maintaining glucose below 140, not hypoglycemia at this level.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.